HomeMy WebLinkAboutT12N R3W SEC 25 S2NE4SW4NW4NE4
,~~'~" MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [] NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO, OF
Liq, capacity in gallons~ Inside length Widti~ Liquid depth
I~ IF HOME.DE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
· -~O z ~ Manufacturer Material Liquid capacity in gallons
D Well Foundation . Nearest Jot llne PERMIT NO.
~ NO. of lines Length of each line Total length of lines Trench width Distance between lines
~ Top of tile to finish grade Material beneath tile Total effective absorption area
Length Width Depth PERMIT
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Bugding foundation Nearest lot line
m DISTANCE TO:
Class Depth Driller Distance to lot line PER MIlT NO.
~ DISTANCE TO: Buildln9 foundation Sewer line Septic tank Absorption area(s)
SOIL TEST RATING
72-013 (Rev. 3/78)
DEF Al', II II:.llf OF HEAL.'FH AND ENVIRONMENT'AL FROT ECT,[O[4
825 L STREET', AIICHORAbE.~ AK 9950].
I:::'FZRM I 'f' Iq[I:
DATE ~:GSUED:
850681 ENGINEERED DESIGN
10 i 17 / 85
APPL I CANT:
ADDRESS:
PHONE:
PI:TTER SENNHAUSER
125600 GiNAMI
ANCHOF~AGE:, AK 99'5 16
345-557 ~
SUBDIVISIOI'4: NE1/4SW1/4NW1/4NE1/4 LOT: S1/,~:.
SE;CTION: 25 'T'OWI'4SI4II=': 12N RANGE: 5W
1.2L,~'A (SQ. FT. OR ACRES)
E L, OCI .....1',.! A
I certify that: 1,, I am f'amiliar wi'Lh t'he requirements f'or on.,-site se~er, s and wells as set
forth by the Mun:[cipality of' Anchorage (MOA) and the .~Lat. e of' Alaska.
2. I will in~ta].l the sv~r'em in accordance wi'Lb all MOA codes and regulations,
and irl compliance wi'cf 'Lhe design critenia oF this permi'[..
3:. I will aclher, e 'Lo all MOA and State of Alas[::a requirements for' the set back
dis'Laric:es ~'l"om ally "' -" .
e*,zscJ, ng well, wastewa'~,ep disposal system (;]F'
IF A I..IF'T STATIOIq IS INSTALI,..ED IN AN AREA COVERED BY MOA BLJ):LDING CODES,
]'HEN (1) ¢;~1~ IELECTR'ICAL PERMIT AND ]:NSPECTION MUST BE:_' OBTAINED; (2) AS-BUILTS
.4II...L NO]- BE[' APPROVED WITHGU] AN ELECTRICAl.._ INSPEETION REPORT; AND (3) THI.--_:
I,:[LEC]RICAL WORK MUST BF_< DGNE BY A LZ[CENSED ELEC-FRIC'IAINI.
AFI L I I., i.-/1'~ 1 . F'ET'ER .~c. NI41-...,&J~sER
PERFORMED FOR:
~ SOILS LOG
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
ENVIRONME NTA~IPRC ~'7:~'(fi~ATi ON
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
S2§ L. Street. Anchorage, Al,sR, 99501 264-4?20 ' / :J 5 1985
SOILS LOG -- PERCOLATION TEST
RECEIVED
LEGAL DESCRIPTION:
OL
4
5
6
7
8
9
10
11
12
13--
14
15
16
17
18
19
20-
SLOPE SITE PLAN
c~,al-er ~(ot~
WASGROUNDWATER S
ENCOUNTERED? ~r~ L
o
P
E
IF YES, AT WHAT
DEPTH? '74
Gross Net Depth to Net
Reading Date
Time Time Water Drop
3 3:o ~
q 3:09
to 3:g'7 E m,~ 8~ a'/8 ~ Vz"
..:PERCOLATION RATE I' Y 3 (minutes/inch)
"t"'TEST RUN BETWEEN ~ "~ FT AND ~. ~ FT
0
S~ ~ V~ Sto'Vq Ncc'V'r N~
~P
QGRE!-'iER ANCHORAGE AREA
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME/'~-/./~. ~'~..~'~.~J~Z:?~¢-~//~'~--' MAILING ADDRESS~///"~'~-fi'~? '*'"~'~"ff~.~ .. PHONE
LOCATION --~/~"~:~ LEGAL DESCRIPTION ~'~-c_~z2~ .~:~/~ ~/~. ~..~
DISTANCE NUMBER OF,~'~z/,',',',',',',',',~zz"/"'~'>'-'~J
FROM WELL/~/2'-/~'' MANUFACTURER'/~--~Z~ ~ MATERIAL~/~'~:~- COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY,~,.~z~>.-'~ GALLONS.
SEEPAGE PIT: /~///~
NUMBER OF PITS DIAMETER
OR WIDTH LENGTH DEPTH
LINING MATERIAL
BUILDING FOUNDATION
CRIB SIZE: DIAMETER__DEPTH DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE ABSORPTION AREA (WALL AREA)
SQ. FT.
ADDITIONAL ABSORPTION
WELL: /./~/~'~/~-~'
TYPE /./(.////~/.~.,xt¢ CONSTRUCTION
BUILDING NEAREST NEAREST
FOUNDATION_ LOT LINE SEWER LINE
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS
DEPTH
SEPTIC
TANK __
DISTANCE FROM:
SEEPAGE
SYSTEM
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
Form NO, EQ-031
DIAGRAM OF SYSTEM
APPROVED ~''~'
G.A.A.B.
GREATER ANCHORAGE ArEA BorOUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
SEWAGE DISPOSA~SYSTEM -- APPLICATION AND PERMIT _
INSTALLATION OF: '~T~O TANK SEEPAGE PIT-- , DRAIN FIELD ., OTHER
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS/~::~//~ ; ~2;~ ~-~ ~ // ~J-- NOTE: THIS PERMIT I$ HOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REOUIREMENT~~
FOUNDATION TO~i~PJJC TANK
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALL
S-EPT~C TANK SEEPAGE PIT -, DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO ~ TANK SEEPAGE Pit
DRAIN FIELD ALSO ~ONSIDER AREA WELLS.
WATEr MAIN TO S~ TaNK /~ SEEPAGE P]T
DRAIN FIELD
DIAGRAM OF SYSTEM
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UND]STUR~3ED SO]L.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE P]T
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
CERTIFY THAT ] AM FAMIL]AR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS iN ACCORDANCE WITH SA]D CODE.
Civil Engineers
JAMES W. ROONEY, P. E.
R&M ENG,NEERING & GEOLOGICAL CONSULTANTS
~IALCOLM A. MENZIES, P.E., L.S.
JAMES H. WELLMAN, P.E.
June 11, 1974
229 EAST 51st. AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA 99503
TELEPHONE 907-279-0483 TELEX 090-35419
Geologists Land Surveyors
JUN 7 197, Al'Y1
Mr. William Breedlove
Star Route A
Box 390B
Anchorage, Alaska
Re:
R & M No. 462036
RALPH R. MIGLIACCIO
Test Hole amd Soil Log Report for Sanitary System, S 1/2, NE 1/4,
SW 1/4, NW 1/4, NE 1/4, Section 25, R3W, T12N, S.M.
Dear Mr. Breedlove:
We are submitting herewith the test boring results and our comments
regarding soil conditions encountered at the subject site. This
investigation was performed in accordance with your request of June 10,
1974, and those procedures outlined in a letter dated September 13,
1971 by Mr. Roll Strickland of the Greater Anchorage Area Borough
Department of Environmental Quality.
A single test hole was put down within the building site area for the
purpose of defining general subsurface soil conditions for the proposed
sanitary system. Excavation was accomplished with a tractor-mounted
backhoe and the test hole was extended to a total depth of 6.0 feet
below ground surface. The final log prepared for the test hole has been
included in Drawing A-01.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & M ENGINEERING & GEOLOGICAL CONSULTANTS, INC.
~Rooney~
JWR:ph
xc: GAAB
ANCHORAGE FAIRBANKS JUNEAU
T.H. 1
6-10-74
0.0~
ORGANICS 0.5'
Sandy Silt, Trace Organics (ML) 1.0'
Silty Sands, Trace Some Gravel (SM)
NOTE:
Gravelly Sand w/Some Silt (SP)
Bedrock
No Water Table
Test hole excavated with tractor-mounted backhoe.
4.5~
6.0'
7.0'
R
Engineering ~ Geological Consultants Inc.
~.N O,qOR AGE FAIRBANKS ALASKA JUN[AU
WILLIAM BREEDLOVE PROPERTY
LOG OF TEST HOLE
Anchorage Alaska
oAr~ 6-10-74 tscAt-~,, 1"=2' laWN .¥ .RDH c.~o 8¥ W, ED IP~oJ. NO. /462036 I~WO ~o. A-01
M-W DRILLING, Inc.
P.O. Box4.1224 · 1310C lerernationalAirport Road
{907) 274-461 ]
ANCHORAGE, ALASKA 99509
DRILLING LOG
Well Owner D~. Lyon
--- _Use of Well
Location (address of:Township,' Range, Section, if known; or distance main road___
Size of casing_
Static water level_
Screen (
Describe screen or perforation
Well pumping test at_ 1 --gallons per
of draxvdown from static level.
Dom
-Depth of Hole z~52 feet Cased to_ 24 feet
55 ft. (aY~Va~j~)C (below) land surface. Finish of well (check one) open end ( X );
); Perforated ( . ).
None
(minute) for~L hours with 100% ~ft.
Date of completion 50 Jul ¥ 1974
WELL LOG
Depth in feet from
grou_nd surface Give details of formations penetrated, size of material,' color and hardness
3 _ TO _.~_
~ TO .
10 _TO 45?__
_TO__
...... TO_
.TO
...... TO
'FO . __
___TO
_ TO__
:rs
?0 ..........
~layne E. Wostber~//
--JMUNlelI:'ALLTY O? ~N¢/.iO~G
DEPT. OF HEALTH
ENVIRONMENTAl. RROTECTION_
1 -- CUSTOMER
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner ,~'~'
Mailing Address
(c) Lending Institution
Telephone: (home)
Telephone
Business '~'~' ~/'
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e)
Mail the HAA to the following address: (or check here ~, if hold for pick up.)
List contact person and day phone number below:
TYPE OF RESIDENCE
Single-Family~ Number of bedrooms
WATER SUPPLY
Individual Well J~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site,[~, Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and statuS.
72-025 (Rev. 7/88) Page I of 2
~¥' peAoJddv
~- JoJ peAoJddv
'lYAOl:lddV SHHQ '9
MUNICIPALITY OF ANCHORAGE (MOA) ~
Health Authority Approval (HAA)
^uv~' oF ,~HE~I~..qST - FEBRUARY 1984
~NV~[,~OUk~N.f^~ S~,~VtC~S DtVlSIONJ43-4744
2, I)J.Cj~ Legal'Description: .5 ~'~//F'~' ~/~/ ,.~¢,0 y~'"//~/~/~/'~'
A. WELL DATA
Well Classification
Well Log Present (Y/N) fY Date Completed J~',JY
Total Depth t/..~..~ C'~ased to-2-4/, ~.~ Depth of Grouting
Yield
U,~, /0'., o~.., ,',/
If A, B, C, D.E.C. Approved (Y/N) /~///~
/ 27,n
Static Water Level ,~, 7 ~ 7~-~?.~'
Casing Height Above Ground ,.~
Electrical Wiring in Conduit (Y/N) 7
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
To Nearest Sewer Service Line on Lot
Water Sample Collected by /¢'~'"*'¢) )/
Pump Set At (z
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
~/OO~ ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
Water Sample Test
Comments ~ ~o,..1
; Date
To Water-Supply Well
To Property Line
To Water Main/Service Line
B. SEPTIC/HOLDING TANK DATA
Date Installed/~/~'?/o°~4' Size /d3OO,~ '~'No. of Compartments
Standpipes (Y/N) 7 Air-tight Caps (Y/N) ~
Depression over Tank (Y/N) /~
Pumping/Maintenance Contact on File,(Y/.N)
Holding Tank High-Water Alarm (Y/N) /"/'/"~f
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
/O~) ~' To Building Foundation
/O ' '~" To Disposal Field
Foundation Cleanout (Y/N)._~_
Date Last pumped /~
;for /Y'//~
Temporary Holding Tank Permit (Y/N)
To Stream, Pond, Lake or Major Drainage Course
Comments ¢ h'~r'~"~ Z)~//j' ~ccord.¢
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /¢)/~ ~/¢ ~'
Width of Field ,_5' '
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation /¢.~ '/' .,Cf-
Lot ./0<¢~ / ~
//~lrm, ¢' Type
AC' Length of Field
Depth of Field ~ L~'"-'-'-'-'-'-'-~
Gravel Bed Thickness
_)~c- Statndpipes Present (Y/N)
Date of Last Adequacy Test
of System Design
To Property Line /¢ /'¢~ '''~
To Existing or Abandoned System on
; On Adjoining Lots
To Water Main/Service Line /
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~" t~'r°'~ ~H/¢$ ~ec*,~'g_.~'
To Cutback (if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have ch,e/cke~,./veri~ed, or conformed to all MOA and HAA guidelines
inspection.
Signed ( ,/'~r~
Date /'~ - / 7
MOA No.
in effect on the date of this
~eer's Seal
Receipt No.
Date of Payment
Amount: $
72-026 (Rev 7~88) Back
:~,~ L/-. Receipt NO
Waiver Fee: $
Date of Payment
Page 2 of 2
LOCATION:
~ESSE, EPPS & POTTS
2220 EAST 88 A¥~FJE
/kNCdO~AGE, AK ~7
(~7) ~i
WAT~ ~r.L TEST
Subdivision:
Block:
Client's Name:
Address:
TESTER:
Initial Reading on Meter: /Dd P ?/
DRAW C-~ONS GALLONS FIELD M~ER
DOWN TIME GPM ~ VOLUME TOTAL MONITOR LEVEL READING
27'
,SD'
/~Ig
77' 13.'~ ~,~ Sf , ~v~ /073/3
gg' I'I.'00 3,3 33 O 73 P.~ IavaYo
/17> I ~,'5/
Prc~uction Rate: / -~ GPM 24-Hour CapacitT Gallcns
NORTHERN TESTING LABORATORIES, INC.
Besse, Epps, & Ports
2220 East 88th Avenue
Anchorage, Alaska 99516
Attn: Andy Potts
Date Arrived: 10/12/88
Time Arrived: 1240
Date Sampled: 10/12/88
Time Sampled: 1115
Date Completed: 10/18/88
Source: 12640 Ginami
Sample ID#: A101288-2
=================================================================================
Parameter Unit Result ADEC MCC*
Nitrate-N mg/1 6.3 10
Reported By: ~ ~ Date: 10/18:88
Francois Rodi~ari, Anchorage Operations Manager
* MCC = Mbximum Contaminant Concentration
NOF THERN TESTING LABORATORIES, NC.
900 UNIVERSITY PLAZA WEST SUITE A FAIRBANKS. ALASKA 99709 907 479-3115
2505 FAIRBANKS STREET ANCi-iORAGE. ALASKA 99503 907 277-8378
Quality Control Report
Client: Besse, Epps~ & Ports
ID#: A101288-2
Listed below are quality control assurance reference samples with a known
concentration prior to analysis. The acceptable limits represent
a 95% confidence interval established by the Enviroamental Protection
AEency or by our laboratory through repetitive analyses of the
reference sample. The reference sa]~ples indicated below were analyzed
at the same time as your samples ensuring the accuracy of your results.
Sample # Parameter Unit Result Acceptable Limit
EPA WP284-3 Nitrate-N mg/1 0.14 0.10 - 0.18
Reported By' ~ ~/~ ' Date' 10/18/88
= ..... :====; ....... ~ ...... ~==== .... =:=========;=======:=== .........
Francois Rodigari, Anchorage Operation Manager
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SiTE SEWER AND WATER FACILITY
264-4720
Application Date i~ ,/ ~--~ /~,5"
GENERAL INFORI'~ATION
(a) Lega~ Description (include lot, block, subdivision, section, fownship, range)
Location (address or directions)
(b) Applicant Name ~¢~r~A~er _ Telephone: Home ~g~-'~/ Business .
Applicant Address I ~ ~l~ ~ i ~ ~ C~t Or~¢ ¢~l ~
(c) Applicant is (check one): Lending Institution ~; Owner/builder~; Buyer ~; Other ~ (explain);
(d) Lending Institution /-')Z/)~t~ J~/~,¢C'" '~'~c,~ /.)]~ _Telephone
Address
(e) Real Estate Company and Agent _ //~,)
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family [] Multi-Family
Number of Bedrooms
Other
WATER SUPPLY
Individual Well [~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite ~' Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
72-025 (11184)
Page I of 2
5.* ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm
Engineer's Seal
DHEPAPPROVAI, ~ .~ ~/~
App roved f o r '~-'{t~/-~.~-~e d roe ms iy~, .'~y/~ '!
~;:rrr:V;:conditi~naI Approva~isappr°v~d~
Conditional/
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
JV~UNICIP,M. ITY OF ANCHORAGE
DEPT. OF HEALTH &
~IRONMENTAL PROTECI'ION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
OCT $ 0 lgl
Legal Description: ~--
N ~u ¢'// N~ Sec , ~ 3 c~.¢ s,/4.
WELL DATA
Well Classification ~r~.~ lf~A, B, C, D.E.C. Appro~,ed (Y/N)
Well Log Present (Y/N) ~ Date Completed "'~ '/-~' / ~ '/~ " Yield
Total Depth ~ ~ ~ ' Cased to '~ ~f ~ Depth of Grouting
Static Water Level '~' ~ Pump set At t.~n ~'
Casing Height Above Ground Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/N)
Separation Distances from We~l:
To Septic/Holding Tank on Lot (~5"' ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~ /~'O ~ ; On Adjoining Lots
To Nearest Public Sewer Line f'~¢~'. To Nearest Public Sewer
Cleanout/Manhole /~/'J" To Nearest Sewer Service Line on Lot
Water Sample Collected by ~'~'/~ ; Date ~ O / 7
Water Sample Test Results -~f__X//"~-~C~/'~r'y - nO
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) ~{~/J ·
Separation Distances from Septic/Holding Tank:
To Water-Supply Well I O,~
To Property Line ~ ~¢ ¢
To Water Main/Service Line
Course ~' ICC' ~
Air-tight Caps (Y/N)
No. of Compartments ~-
Foundation Cleanout (Y/N) ~
Date Last Pumped N, ,¢J-. ~__~,,¢¢,0' ~"¢,,9,¢.¢'j
N,r'~- · ;for N,/~.
Temporary Holding Tank Permit (Y/N) ~-tJ'. --
To Building Foundation '
To Disposal Field I1~ r
To Stream, Pond, Lake, or Major Drainage
Page 1-of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test ~¢/~t,
Type of System Design
Length of Field ~-I '
Depth of Field ~ ~-
Gravel Bed Thickness O"" /~
Standpipes Present (Y/N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~ (~O¢
TO Building Foundation ~ f'~o *
Lot ~ I~-~'~
To Water Main/Service Line ~¢/J'.
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments i\(,~,¢ ¢_~t'~'/~ ~'~(~' ,~,,q~-/~//.~./
To Property Line '~" ~'*
To Existing or Abandoned System on
; On Adjoining Lots '~' I oo~
To Cutbank (if present) _l~,~-,
'~' ~.OO ~
D. LIFT STATION ~,/~,
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted BCdroom Rating Against HAA Request **
1 9ertify that I:ha~,e Check'ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~¢~""/~ ~ ~¢.~.¢.-a~ Date
Company f~"~,.,~ T~c'~/n~c.~(£'C~MOA No.
Receipt No. ~q'%.~ ~
Date bi Payment I 0 ;~ ~0"~
Amount: $ t~'~
Page 2 of 2
72-026 (11/84)
Engineer's Seal
" ~ DATE RECEIVED
INSPECTION APPOINTMENTS ',~.~
TIME TIME TIME
DATE DATE DATE
MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~EPT' OF HEALTH &
825 L Street - Anchorage, Alaska g~501 ENVIRONMENTAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION MAR ~ lg81
Telephone 2~4-4720
MAILING ADDRESS ·
PROPERTY RESIDENT (If different from above) PHONE
2, BUYER . . PHONE
MAIUNG ADDRESS
MAILING ADD~ES8
DESCRIPTION ~
6, TYPE OF RESIDENCE ~v NUmB'ER OF~BEDROOMS
,~'~, {~ One '.[] Four [] Other__
~ SINGLE FAMILY ~ Two [] Five
[] MULTIPLE FAMILY Three [] Six
7. WATER SUPPLY
[~] INDIVI DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilJed prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if a~ailable.)
8. SEWAGE DISPOSAL SYSTEM
,ND,V,DUA' ON-S,TE-- YEAR ON-S,TE SYSTE AS,,STAL'E .
[] PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
INDIVIDUAL
COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[]INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[~Septic Tank or [] Holding Tank
Size: ~(~/--.) D If Tank is homemade
give dimensions:
NUMBEROFBEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATEINSTALLED
INSTALLER
SOILS RATING
TYPEOFTANK MANUFACTURER
TOTALASSORPTION AREA
4. DISTANCES
WELL TO:
MATERIAL l~~,~ ~_~.'
Septic/Holding Tank IAbsorption Ar~e Sewer Line
[] OTHER
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~A~PROV ED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE
72-010 (Rev. 6/79)
DATE:
TO:
FROM:
SUBJECT:
NtumCipality of Anchorage
MEMORANDUM
April 24, 1978
File
Senior Environmenta~ Specialist
T12N R3W Section 25/S½ SE~ SW~ NE~
~d~tewar~.~P.roperty ,>
Review of the subject property, i.e., well quality and
on-site sewage disposal, was conducted between this department,
Kyle Cherry of the Department of Environmental Conservation,
and Earl Clabo, excavator and agent for the upgrading,
resulted in the following:
(1)
Well - analysis results in coliform bacteria. Currently
a chlorinator is in service. The contamination problem
must be resolved or a new well risked.
(2) Sewer - a holding tank is the only viable method
agreed upon. Location must be eighty(80) feet from
the well. Depending upon outcome of the well, the holding
tank will necessitate a lift station if the existing well
is utilized.
Les N. Buchho~
Senior Environmental Specialist
LNB/ljh
91-010 (4/76)
April 11, 1978
Kyle J. Cherry,
Regional Environmental Supervisor
State of Alaska
Department of Environmental Conservation
Southcentral Regional office
~38 Denali Street
Mac Kay Building - ROOm 1208
.Anchorage, Alaska 99501
S%~ject: T12N R3W Section 25 S% SE% SW~ NEb
Ed Stewart Property
Dear ~o Cherry:
Earl Clabo has been retained by Ed Stewart to resolve the
q~estions conerning th~ inadequate distance separation of
well~ septic tank and seepage rings on the above referenced
property.
~. Ciabo has informed me, this date, that you have offered
your services to assist ~hr. Clabo in resolving the problem.
You are probably aware that the involvement of this office
with this problem dates back several years.
Reference is made to a letter from Lynn Coad to Edwin Stewart
dated Dec~ber 4; 1974 regarding inspection, Mr. Coad made
of ~,e s~bject property on l~ove~ber 26, 1974.(copy attached)
and the raost recent inspection by Mr. Robert Pratt of this
office(copy attached). Mr. Pratt will be available to assist
you in your evaluation of the problera described.
If there are any questions, please contact us at 264-4720.
Sincerely,
Joseph S. Blair,
Environmental Services Manager
JSB/lJh
at tacbJ~ent s